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100 Highway 21 N Ellington MO 63638-9409 | |
(573) 663-2511 | |
(573) 663-2815 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 100 Highway 21 N, Ellington, Missouri |
Authorized Official Name and Position | Paula E Harris (VICE PRESIDENT REGIONAL OPERATIONS) |
Authorized Official Contact | 5737780020 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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100 Highway 21 N Ellington MO 63638-9409 Ph: (573) 663-2511 | 100 Highway 21 N Ellington MO 63638-9409 Ph: (573) 663-2511 |
NPI Number | 1285050948 |
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Provider Enumeration Date | 03/05/2014 |
Last Update Date | 03/05/2014 |
Identifier | Type | State | Issuer |
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1285050948 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |